Clinical and laboratory characteristics, staging, and outcomes of individuals with AIDS-associated Kaposi's sarcoma at an university hospital

Abstract: Background: Kaposi's sarcoma continues to be the most common human immunodeficiency virus - associated neoplasm with considerable morbidity and mortality. Objective: To describe the clinical and laboratory characteristics, initial staging, and outcomes of aids patients with Kaposi's sarcoma at an university hospital of Recife, Pernambuco. Methods: This is a descriptive study with analytic character, retrospective, of a case series between 2004 and 2014. Results: Of the 22 patients included in the study, 20 were aged <40 years (72.7%). The majority had CD4+ T lymphocyte counts of <200 cells/mm3 (77.3%) and human immunodeficiency virus loads of <100,000 copies/mL (78.9%). Lesions were most commonly observed on the skin (90%), and internal organs were affected in 11 of the 22 patients. Only 7 (31.8%) of the 22 patients were undergoing antiretroviral therapy (ART) at the time of Kaposis sarcoma diagnosis, and the initial disease staging classification was high risk (Aids Clinical Trials Group Oncology Committee) in 19 of the 22 patients (86.4%). Regarding Kaposi's sarcoma treatment, 17 of 22 patients (77.3%) underwent systemic chemotherapy + ART and 5 were treated exclusively with ART. Eight of the 22 patients died (36.5%); of these, 87.5% had died within one year of Kaposi's sarcoma diagnosis. Limitation of the study: Without a control group, this study cannot be used to generate hypotheses. Conclusions: Despite the association between aids and late Kaposi's sarcoma diagnosis in the study population, including an unfavorable risk at the time of staging, a lower mortality rate was observed relative to other studies; this might be related to access to a specialized health service.

FIRST BRAZILIAN CONSENSUS ON MULTIMODAL TREATMENT OF COLORECTAL LIVER METASTASES. MODULE 1: PRE-TREATMENT EVALUATION / I CONSENSO BRASILEIRO DE TRATAMENTO MULTIDISCIPLINAR DE METÁSTASE HEPÁTICA COLORRETAIS. MÓDULO 1: AVALIAÇÃO PRÉ-TRATAMENTO

Background : Liver metastases of colorectal cancer are frequent and potentially fatal event in the evolution of patients with these tumors. Aim : In this module, was contextualized the clinical situations and parameterized epidemiological data and results of the various treatment modalities established. Method: Was realized deep discussion on detecting and staging metastatic colorectal cancer, as well as employment of imaging methods in the evaluation of response to instituted systemic therapy. Results : The next step was based on the definition of which patients would have their metastases considered resectable and how to expand the amount of patients elegible for modalities with curative intent. Conclusion : Were presented clinical, pathological and molecular prognostic factors, validated to be taken into account in clinical practice.

Racional : As metástases hepáticas de câncer colorretal são evento frequente e potencialmente fatal na evolução de pacientes com estas neoplasias. Objetivo : Neste módulo procurou-se contextualizar esta situação clínica, bem como parametrizar dados epidemiológicos e de resultados das diversas modalidades de tratamento estabelecidas. Método : Foi realizada discussão sobre como detectar e estadiar o câncer colorretal metastático, bem como o emprego dos métodos de imagem na avaliação de resposta ao tratamento sistêmico instituído. Resultado : Fundamentou na definição de quais pacientes teriam suas metástases consideradas ressecáveis e de como se poderia ampliar a gama de pacientes submetidos às modalidades de tratamento ditas de intuito curativo. Conclusão : Foram apresentados os fatores prognósticos clínicos, patológicos e moleculares com validação para serem levados em consideração na prática clínica.

Hyperglycemia increases the complicated infection and mortality rates during induction therapy in adult acute leukemia patients

OBJECTIVE: To determine the prevalence of hyperglycemia during induction therapy in adult patients with acute leukemia and its effect on complicated infections and mortality during the first 30 days of treatment. METHODS: An analysis was performed in a retrospective cohort of 280 adult patients aged 18 to 60 years with previously untreated acute leukemia who received induction chemotherapy from January 2000 to December 2009 at the Hemocentro de Pernambuco (HEMOPE), Brazil. Hyperglycemia was defined as the finding of at least one fasting glucose measurement > 100 mg/dL observed one week prior to induction therapy until 30 days after. The association between hyperglycemia and complicated infections, mortality and complete remission was evaluated using the Chi-square or Fisher's exact tests by the Statistical Package for Social Sciences (SPSS) in the R software package version 2.9.0. RESULTS: One hundred and eighty-eight patients (67.1%) presented hyperglycemia at some moment during induction therapy. Eighty-two patients (29.3%) developed complicated infections. Infection-related mortality during the neutropenia period was 20.7% (58 patients). Mortality from other causes during the first 30 days after induction was 2.8%. Hyperglycemia increased the risk of complicated infections (OR 3.97; 95% confidence interval: 2.08 - 7.57; p-value < 0.001) and death (OR 3.55; 95% confidence interval: 1.77-7.12; p-value < 0.001) but did not increase the risk of fungal infections or decrease the probability of achieving complete remission. CONCLUSION: This study demonstrates an association between the presence of hyperglycemia and the development of complicated infections and death in adult patients during induction therapy for acute leukemia.

Paliative chemotherapy based in etoposide Leucovorin and 5 Fluorouracil (ELF) using leucovorin in low dose in the treatment of patients with advanced gastric cancer

A great percentage of diagnosed gastric cancer cases are encountered in advanced stages with distant metastases. In these cases, the standard treatment is palliative chemotherapy. In the ELF chemotherapy regime, the dose of leucovorin (Lv) varies from 300 to 500mg/m2. However, there are no studies that demonstrate therapeutic equivalence between high and low doses of Lv. OBJECTIVE: Retrospectively analyze the response rates and toxicity profile of the ELF scheme with low doses of Lv offered to patients with metastatic gastric cancer. MATTERS AND METHODS: Evaluated were patients treated with etoposide (120mg/m2/day), Lv (20mg/m2/day) and 5-fluorouracil (500mg/m2/day), D1 and D3 cycles repeated every three weeks. RESULTS: Sixty-eight patients were treated, 69% men, with median age of 60.24 years. Occurred six complete responses (8.8%), five partial responses (7.4%) and 38.2% of the patients presented stable disease. The median overall survival was 9.15 months (IC95%, 6.06-12.95), while patients with overall response was 16.05 months (IC95%, 10.48-21.63) and in those that presented stable disease or progression was 9.01 months (IC95%, 4.71-13.31; p=0.669). Grade III and IV low frequency toxicity was observed. CONCLUSIONS: In the present sample, the ELF regime with low-dose leucovorin presented an excellent toxicity profile. In spite of the low response rate, the respondent patients presented an equivalent overall survival to the other regimens of the literature.

Ameloblastoma: a case report

Ameloblastoma is a neoplasm arising from the epithelium involved with the formation of teeth. They are usually benign, locally aggressive and recurrent, however, metastases are rare. The treatment is not clearly defined and the main therapeutic tool is surgical intervention. Radiotherapy and chemotherapy have not been shown encouraging results. As there are few cases reported in the medical literature and the treatment is challenging, we reported a case of a 53-year-old woman with recurrentameloblastoma, with local and distant recurrence, that remains alive over 25 years from diagnosis.